Seminars in Plastic Surgery最新文献

{"title":"Reconstructive Microsurgery at Chang Gung (Part 1): Upper and Lower Extremities.","authors":"Fu-Chan Wei","doi":"10.1055/s-0045-1810061","DOIUrl":"10.1055/s-0045-1810061","url":null,"abstract":"","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"39 3","pages":"120"},"PeriodicalIF":1.2,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12334252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orthoplastic Approach to Extremity Reconstruction: A Paradigm Shift in Integrated Limb Salvage.","authors":"Cheng-Hung Lin, Ying-Chao Chou, Chung-Chen Hsu, Ren-Wen Huang, Chih-Hung Lin","doi":"10.1055/s-0045-1810090","DOIUrl":"https://doi.org/10.1055/s-0045-1810090","url":null,"abstract":"<p><p>The orthoplastic approach to extremity reconstruction represents a paradigm shift in the management of complex limb injuries, integrating orthopedic and plastic surgery principles to optimize functional and aesthetic outcomes. This review examines the evolution of this approach, its hierarchical framework for addressing tissue defects, and the essential technical competencies required for successful implementation. Key components of orthoplastic extremity reconstruction are illustrated through current evidence focusing on soft tissue management with high free flap success rates, vascularized bone transfers utilizing fibula, iliac crest, and medial femoral condyle flaps, and advanced techniques for amputee reconstruction including regenerative peripheral nerve interfaces and targeted muscle reinnervation. Meta-analysis evidence demonstrates that the synergistic collaboration between orthopedic and plastic surgery specialties achieves significant reduction in infection rates, improved limb salvage rates, and decreased health care costs through reduced hospital stay and revision surgeries. This article emphasizes the importance of multidisciplinary collaboration, comprehensive preoperative planning, and technical expertise in achieving optimal results in complex extremity reconstruction while addressing recent advances in reconstructive microsurgery protocols.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"39 3","pages":"129-139"},"PeriodicalIF":1.2,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12334260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trophic Ulcer Elimination in Free Flap Reconstructed Weight-Bearing Plantar Defect: A Clinical Challenge.","authors":"Chih-Hung Lin, Cheng-Hung Lin, Chung-Chen Hsu","doi":"10.1055/s-0045-1809701","DOIUrl":"10.1055/s-0045-1809701","url":null,"abstract":"<p><p>Trophic ulceration represents a significant complication following free flap reconstruction of the plantar surface. Despite successful microvascular tissue transfer for posttraumatic defects, these ulcers develop due to biomechanical incompatibility, sensory deficits, and altered pressure distribution. This review examines the multifaceted pathophysiology of trophic ulcers in reconstructed plantar surfaces, comparing tissue characteristics across different flap options and exploring evidence-based preventive and management strategies. Understanding the biomechanical principles, including friction forces, shear stress, and viscoelastic properties, is crucial for optimizing surgical planning and postoperative care to reduce ulceration risk and preserve long-term foot function.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"39 3","pages":"175-180"},"PeriodicalIF":1.2,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12334258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Free Functioning Muscle Transfer for Lower Limb Reconstruction: A Biomechanical Approach.","authors":"Ren-Wen Huang, Chung-Chen Hsu, Cheng-Hung Lin, Chih-Hung Lin","doi":"10.1055/s-0045-1809652","DOIUrl":"10.1055/s-0045-1809652","url":null,"abstract":"<p><p>Free functioning muscle transfer (FFMT) is widely used to reconstruct complex lower limb defects involving muscle deficits. This review explores ways to optimize FFMT outcomes by examining biomechanical considerations, particularly balancing the needs for stable joint positioning (isometric function) and active motion (isotonic function) for specific reconstructive objectives. We discuss knee extension, ankle dorsiflexion, and ankle plantarflexion reconstruction, recommending suitable donor muscles based on their mechanical properties and functional requirements. Important considerations include careful donor muscle selection, accurate muscle tensioning during surgery, secure tendon attachment methods, and targeted rehabilitation timed with nerve recovery. This approach offers practical advice for surgeons aiming to restore movement and improve overall function in patients undergoing complex lower limb reconstructions.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"39 3","pages":"149-156"},"PeriodicalIF":1.2,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12334253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence and Machine Learning in Reconstructive Microsurgery.","authors":"Ta-Chun Lin, Hsi-An Yang, Ren-Wen Huang, Cheng-Hung Lin","doi":"10.1055/s-0045-1810062","DOIUrl":"https://doi.org/10.1055/s-0045-1810062","url":null,"abstract":"<p><p>Artificial intelligence (AI) and machine learning (ML) technologies are transforming reconstructive microsurgery through data-driven approaches that enhance precision and standardize clinical workflows. These innovations address long-standing challenges, including subjective assessment methodologies, operator-dependent decision-making, and inconsistent monitoring protocols across the perioperative continuum. Contemporary applications demonstrate remarkable capabilities in preoperative risk stratification, with ML algorithms achieving high predictive accuracy for complications such as flap loss and donor site morbidity. CNNs have revolutionized perforator localization, with advanced models achieving Dice coefficients of 91.87% in anatomical structure detection from CT angiography. Intraoperative assistance through AI-enhanced robotic platforms provides submillimeter precision and tremor filtration, particularly beneficial in supermicrosurgery involving vessels measuring 0.3- to 0.8-mm diameter. Postoperative monitoring represents a particularly promising domain, where AI-based image analysis systems achieve 98.4% accuracy in classifying flap perfusion status and detecting early vascular compromise. Automated platforms may enable continuous surveillance with reduced clinical workload while maintaining superior consistency compared with traditional subjective methods. Patient communication benefits from AI-driven visual simulation and large language models (LLMs) that generate personalized educational materials, enhancing informed consent processes. Critical implementation challenges include data quality, algorithmic bias, and inherent dataset imbalance, where complications represent rare but clinically crucial events. Future advancement requires explainable AI systems, multi-institutional collaboration, and comprehensive regulatory frameworks. When thoughtfully integrated, AI serves as a powerful augmentation tool that elevates microsurgical precision and outcomes while preserving the fundamental importance of surgical expertise and clinical judgment.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"39 3","pages":"190-198"},"PeriodicalIF":1.2,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12334263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Yu-Te Lin, MD, MS, FACS and Cheng-Hung Lin, MD, MBA, FACS.","authors":"Edward P Buchanan","doi":"10.1055/s-0045-1810089","DOIUrl":"10.1055/s-0045-1810089","url":null,"abstract":"","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"39 3","pages":"119"},"PeriodicalIF":1.2,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12334257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascularized Composite Allotransplantation: Basic Research and Clinical Experience at Chang Gung.","authors":"Ren-Wen Huang, Madonna Rica Anggelia, Hui-Yun Cheng, Fu-Chan Wei, Cheng-Hung Lin","doi":"10.1055/s-0045-1810065","DOIUrl":"10.1055/s-0045-1810065","url":null,"abstract":"<p><p>Vascularized composite allotransplantation (VCA) represents one of the most complex frontiers in reconstructive surgery, requiring simultaneous transfer of multiple tissue types, including skin, muscle, bone, and nerves. Success depends on the multidisciplinary integration of immunology, surgery, rehabilitation, and psychology. Chang Gung Memorial Hospital has established itself as a pioneer in clinical VCA in Taiwan, contributing significantly through innovative basic research and successful clinical outcomes. This review explores our institutional experience, highlighting clinical cases and groundbreaking preclinical research within our comprehensive VCA program.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"39 3","pages":"181-189"},"PeriodicalIF":1.2,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12334255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Soft Tissue Reconstruction in the Extremities: Principles, Techniques, and Outcomes.","authors":"Che-Hsiung Lee, Shih-Heng Chen","doi":"10.1055/s-0045-1809975","DOIUrl":"https://doi.org/10.1055/s-0045-1809975","url":null,"abstract":"<p><p>Soft tissue reconstruction in the extremities is complicated by the fact that injuries often involve composite defects of skin, muscle, tendon, nerve, and bone. In both the upper and lower limbs, achieving reliable soft tissue coverage, restoring function, and reducing complications are critical goals. The upper extremity requires precision and fine manipulation, whereas the lower limb should be reconstructed to support weight-bearing and mobility. Free flaps have become a routine part of the surgical armamentarium, offering flexible solutions tailored to different needs. Donor sites in the lower extremities are favored due to the availability of high-quality tissue, minimal visible scarring, and the possibility of a two-team approach. Careful planning not only improves wound healing but also accelerates rehabilitation and reduces the need for revision surgeries, underscoring the importance of flap choice, anatomical knowledge, and surgical skill.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"39 3","pages":"140-148"},"PeriodicalIF":1.2,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12334261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distal Digit Replantation: Challenges and Strategies to Improve Outcomes.","authors":"Chung-Chen Hsu, Yun-Jui Lu","doi":"10.1055/s-0045-1809651","DOIUrl":"https://doi.org/10.1055/s-0045-1809651","url":null,"abstract":"<p><p>Digit replantation has undergone significant advancements since the 1960s. Despite progress, distal digit replantation remains one of the most challenging microsurgical procedures due to technical and clinical complexities. This review examines current challenges, strategic solutions in distal digit replantation, grounded in clinical experience and literature review. Key obstacles include managing minute vessel structures, venous congestion, and the critical condition of no available vessels for revascularization. Advances in surgical techniques, including preosteosynthesis vein grafting, intravascular stent, solitary central pulp artery bifurcation division, subdermal pocketing method, and postoperative management, have enhanced outcomes.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"39 3","pages":"121-128"},"PeriodicalIF":1.2,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12334254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144818010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancement in Vascularized Toe PIP Joint Transfers: Technical Evolution and Current Practices.","authors":"Che-Hsiung Lee, Yu-Te Lin","doi":"10.1055/s-0045-1809370","DOIUrl":"https://doi.org/10.1055/s-0045-1809370","url":null,"abstract":"<p><p>Vascularized toe proximal interphalangeal joint transfer has evolved as a biological solution for posttraumatic finger joint reconstruction. Extension lag has been recognized as a major challenge since its introduction in the 1980s. A significant advancement came from the 2013 anatomical study that characterized two distinct patterns of toe extensor mechanism: Type 1 (>95%) lacking obvious central slip insertion, and Type 2 (<5%) with clear central slip insertion. This understanding led to customized reconstruction strategies based on both donor toe anatomy and recipient finger condition. Various techniques, including centralization, direct repair, and central slip reconstruction, have been developed. The Te technique was developed to minimize bone manipulation while achieving similar functional outcomes to the traditional Stack technique. Current evidence demonstrates that proper execution of central slip reconstruction can achieve consistent functional results regardless of the technique chosen.</p>","PeriodicalId":48687,"journal":{"name":"Seminars in Plastic Surgery","volume":"39 3","pages":"164-169"},"PeriodicalIF":1.2,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12334256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}